Ghana Adventure

this past saturday i signed up to visit
pantang psychiatric hospital in accra. there's a group from the ship that goes every saturday to spend a few hours visiting with the patients. i wasn't sure what to expect...i had heard stories that many of the patients were quite "wild" last time they went...even though i spent two weeks on an inpatient psychiatry ward in medical school i found myself a little nervous as we got ready to leave.

the hospital seemed a little run
down from the outside but turned out to be very nice (and clean). the patients were so happy to see us...we visited ward 13, comprised of middle-aged men with chronic psychiatric problems. some of the women from the next ward came over to join in the fun as well. we set up a bunch of stations around the room...board games, fingernail painting, hand massage, prayer,
music/drums and a balloon animal station (thanks to mario, the only italian guy on the ship...hilarious). at the end we served them lemonade and cookies.

i spent a long time talking to ernest, one of the nurses there and found out that the hospital staff, medications and facilities are funded by the government but the clothing and food are donated by nonprofit organizations. the patients are referred by the police, court orders, family members or self-referrals (seemed very similar to the US system). he said that many of the patients never have any visitors so it's like a "holiday" when we come every week.

the patients seemed well cared for and had a blast with all of the activities. i spent two hours playing the board game "sorry" with three elderly gentlemen...they were brutal about sending me back to home base...i ended up finishing fourth! in the end i had a great time and it felt good to give these guys a break from the routine. there was no "wild" behavior...in fact, the only sad part about the day was that most of the patients were highly sedated and seemed a little zoned out.

afterwards i went with some friends to
tema market. it's basically the equivalent of wal-mart here in tema...where all the locals to to get food, toiletries, fabrics, etc. it is such a colorful maze of activity...women carrying huge loads of stuff on their heads, piles and piles of tomatoes, plantain, okra, rice and beans. butchers slicing up seafood, goats, cows and chickens right before your eyes. anyways, i love it because it's so authentically african...colorful, busy, no tourists. and you see some crazy stuff there...pigs feet, dried eel and huge live snails (shown in pic)...they were crawling all over the table. (ew!)

ps: my dr. pepper drought ended on day 65. and yes, it was fabulous.

the good:
-- my commute to work...traffic: occasional pedestrian, flights of stairs: 1, time in transit: 20 seconds walking, 6 seconds jogging.

-- being gently rocked to sleep by the boat.

-- my "food soulmate," meg...we both always get double helpings of dessert (and sometimes even eat our dessert first), don't like raw tomatoes, have severe snack attacks late at night, love spicy foods, love anything with peanut butter on it, both game to try any ghanaian dish, etc etc.

-- african-style worship services on sunday mornings.

-- no studying!!

-- the graciousness and exuberant hospitality of the ghanaian people.

-- meeting people from all over the world...so far i have received open invitations to stay at homes in south africa, london and australia.

-- saturday night movies projected outdoors on the aft deck.

-- my roommates, for not only being hilariously fun girls but also for putting up with my grisly, non-morning-person self each AM.

-- the two scottish folk dances (ceilidhs) we had last month, complete with a live band (including accordion!)...think square dance.

-- red red and fried plantain...mmmmm.

the bad:
-- my commute to the toilet...climb down from top bunk, being careful not to slip and fall onto concrete floor in my sleepy state, go out the door into the hall, quickly dash down the hall towards the stairs hoping that no one sees me in my pj's, go up one flight of stairs and down another hall, finally reach bathroom and pray that it is not already occupied in which case i have to climb a second flight of stairs...argh (but hey, at least i have access to a toilet)

-- lying awake in my cabin listening to the jackhammer-like noise that the ropes make when the boat rocks too enthusiastically.

-- 63 consecutive days without a dr pepper. and counting.

the divine:
-- watching the ladies who had vesicovaginal fistula (VVF) repairs celebrate their newly restored bodies during their "dress ceremony" (wearing traditional african dresses, singing and dancing and praising God to the beat of an african drum) .

-- the fact that every single person on this ship, from the most highly esteemed surgeon to the engine room worker to the cook, is here to serve the people of ghana...and does so with joy, compassion and a great sense of humor.

-- the fact that my dry spell may be ending...the ship recently received a container from the US and i have heard first-hand reports that cases of dr. pepper were seen being unloaded from it today...woo hoo!

-- that God has finally given me peace about a specialty choice...but you'll have to wait til next time to find out what it is! (i know, i'm cruel. however, for any of you out there who would like to make a prediction, feel free to do so by posting a comment on this blog entry...there may or may not be a prize for those who guess correctly. and if you are among the 3-4 people who i've already told, you are ineligible for said possible prize).

sorry for not writing anything yet this week but i am exhausted...the OR schedule has been crazy, some wild things have happened in surgery (note: nicking/cutting or otherwise injuring an iliac vein is not a good idea), and i've only gotten dinner 1 out of four days this week. argh. anyhow, don't have time for details now because on thursday nights my friend meg and i serve as baristas at the sala victoria cafe here on board, which is kind of funny since i'm not much of a coffee drinker (however we do serve top-quality hot chocolate as well). meg has taught me well though and now i can whip up a tall double-shot caramel hazelnut latte with the best of 'em. we actually use starbucks coffee which starbucks has donated to mercy ships (a 30 year supply!) so it's pretty good...and cheap: a mocha or latte for 75 cents. meg and i have a blast with it and many of our customers comment that we seem to be "naturals" behind the bar...we've had requests for dance routines a la coyote ugly but have managed to come up with good excuses so far (including meg's broken pinky toe...no joke!). best part is that after we close at the end of the night we make ourselves all sorts of crazy coffee concoctions (job perk) and thus guarantee that we won't fall asleep before 2am...my personal favorite so far is a white chocolate coconut almond mocha.

this past wednesday i started my new job in the operating room. there are three ORs on the anastasis...room 1 is currently plastics, room 2 is usually maxillofacial (maxfax) but is right now in the middle of a two week general surgery stint and room 3 is ophthalmology. ideally, each room would have an anesthesia provider, a circulating nurse, a scrub tech and an assistant in addition to the surgeon. however, right now we're extremely short-staffed in several areas...most drastically sort of anesthesiologists. there was a four week gap in the schedule where mercy ships had no volunteer anesthesiologists scheduled so they've sort of piecemealed a group together...we currently have one CRNA from the US and one local ghanaian equivalent of a CRNA. the US guy is working rooms 1 and 3 (ophtho does not require much in the way of anesthesia) while the ghanaian guy is working room 2. apparently the OR director did not feel extremely confident in the ghanaian guy's airway skills because she is allowing him to do only spinal anesthesia.

the other shortage is in nursing and assistant staff. i have been assigned to room 2, which up until wednesday only had one qualified scrub tech (fiona from australia), no assistant and no circulator (they had been pulling a nurse from the wards to circulate). so needless to say they were very happy to see me...however, i was a little bit nervous as a) i am not terribly familiar with general surgery cases and b) i have never worked as a circulator or scrub tech...! fortunately for me fiona is one of the nicest, most patient people i have ever worked with in my life (sort of a female version of kevin sexton...they both should be nominated for sainthood) and she did an amazing job of putting up with my inability to remember certain details even after i'd been reminded three times.

so that's where i found myself wednesday morning...part of the motley crew of room 2, with fiona as the only sane, experienced one of the group. i quickly realized why the OR director had been keeping the ghanaian CRNA on a short leash...he does a terrific job of administering spinal anesthetics but then seems to sort of blank out for the rest of the procedure (i.e. fails to take notice when oxygen sats suddenly drop to 80%) so fiona and i have to keep an eye on the monitors in addition to our duties. we had four hernia repairs scheduled on wednesday which in the US would be about as boring a day as i could imagine...but not in africa. these hernias are gigantic...at least as big as cantaloupes...and the sacks have proven to contain all sorts of interesting things such as inflamed appendices...we've so far done two combined hernia repairs/appendectomies (Amyand's hernia) which are very rare. also there are no laparoscopes here, so these are all done as open procedures.

for the first few cases fiona was the scrub tech and assistant (we don't have enough staff right now to have a dedicated assistant in our room) while i circulated. under normal circumstances i would have been quite enjoying myself as a circulator but i have neglected to tell you about one important detail...on tuesday the ship had to shut down it's air conditioning system for repairs...as we are in fact in africa that meant that the temp on board quickly shot up and by wednesday morning room 2's ambient thermometer read 95 degrees farenheit. therefore a great deal of my circulating duties involved wiping copious amounts of sweat off the faces of fiona and dr. ralph (general surgeon here for 2 weeks from the US...it is mercy ships tradition to call doctors by "dr. first name") as to avoid literally showering the open wound with sweat. normally i would have been itching to scrub in but in this case i was thankful not to have the extra layer of clothing on as i too was sweating through my short sleeved scrubs. however, in the afternoon the tables turned and fiona decided to train me to be a scrub tech while she circulated...

let me tell you, i now have a whole new respect for scrub techs as their job is no joke. i consider myself a mildly intelligent person but i felt completely incompetent during that first case...and it was complicated by the fact that i was trying to both assist and do the scrub tech thing at the same time...at one point i was trying to do a count on the ten zillion raytecs i had open while holding three retractors, loading up suture and desperately trying to differentiate my allis, babcock and kocher clamps...all the while the patient's HR was down to thirty-something (ended up getting two doses of atropine), the surgery had gone on so long that the spinal anesthetic was in danger of wearing off and i was dripping (no, make that gushing) sweat from every pore on my body.

but don't let me fool you...i'm having a blast. by my third hernia case i had finally gotten all of the instruments down, had streamlined my scrub tech approach and was deftly (sort of) tying off vessels left and right. and the OR staff here is awesome...there's this very positive vibe that you don't always get back home. i think it's because the type of people attracted to medical missions are generally pretty selfless, caring folks...have yet to hear a surgeon make a fuss about anything.

thursday and friday were a little more calm, thank goodness. friday also brought restoration to the air-conditioning...now room 2's thermometer reads 65 degrees...aaaah.

as far as i know i'll be in room 2 for the rest of my time here which i'm really excited about because dr gary (the long-term maxfax surgeon who did peace's surgery last month) is coming back from vacation in two weeks and he's a great person to work with...very inspiring on many levels. i think that they are expecting the arrival of more operating room staff soon at which point i will switch to full time assissting (my favorite job)...am glad to have the experience of seeing things from a circulator and scrub tech point of view though.

plan to take my camera to the OR sometime soon...will post pics as soon as i have some.

yesterday morning our captain informed us of a public health report that the UN recently released concerning Ghana...apparently the sewage treatment plant in Accra (capital city of 2 million people) has been on the blink since march 2005. so what's a city to do when it can't treat its dirty sewage? why dump it straight into the atlantic ocean of course! so apparently 80% of accra's sewage has been released untreated into the ocean for the past year...that's the "waste products" of 1.6 million people...makes me a little nauseus to think about. craziest part is the quote from one of accra's goverment officials: "It is a mighty ocean out there. As far as I am concerned, [dumping sewage] doesn't do anything bad to anyone." needless to say i won't be swimming in the ocean or eating any local fish. for the full report, click here.

on a more positive note, the public health issue that i was most concerned about before coming to ghana seems to be under relatively good control. the HIV infection rate in ghana dropped from 3.6% to 3.1% last year and the trend seems to be continuing downward. on the anastasis we have not had a single patient test positive for HIV since i've been here (however we don't test every single patient). i kind of chuckled at this billboard when i first saw it but hey, seems to be working!

had a wonderful (though hot!) first day as part of the operating staff...will give full details next time.

have spent a relaxing weekend on the ship, so
no new adventures to report. on wednesday i will start my new job as a surgical assistant...i'm really looking forward to it but also will miss being out in the community every day.

at right is a mother we saw in clinic last week. all the ghanaian mothers carry their babies on their backs like this...so cute! still haven't figured out how they keep the babies from falling out the bottom.

below is a typical lunch at clinic...every morning we bring a cooler that the galley stocks with raw meat, rice and vegetable oil. lucy (a local girl) picks it up and takes it to her home where she makes our lunch, then brings the hot
dishes back to the clinic at noon for us
to eat. (we also give her money to buy vegetables, plantains, etc to add). there are three or four different dishes she makes, usually rice, meat and a spicy sauce. the food is wonderful...something i will really miss when i start working on the ship this week!

so last week i got my first 1-5-1 call,
which is when the receptionist gets on the overhead intercom and says "so-and-so, please dial 1-5-1." generally it means that someone from home has called the ship...i was a bit nervous because i couldn't imagine why my parents would be calling me when they knew i would be calling them the next day...unless something bad had happened. so i nervously picked up the phone and heard..."jennnnnnnnn! i'm in accra!" it was kojo, one of my medical school classmates who is from ghana! he's doing his residency in south carolina right now but had to come back here for a week to get some visa issues sorted out. both of our schedules were busy but we managed to get together saturday afternoon through sunday morning...stayed at his auntie's house in accra (and she cooked the most awesome ghanaian food!) it was great to hang out with him, a nice surprise to have a familiar face while so far from home.

saturday morning the dental team
took a little trip to cedi bead industry, outside of a small town an hour and a half north of here. the road there was two dirt tire tracks through the jungle and so i wasn't sure what to expect...turned out to be one of the coolest things i've seen since i've been here. glass bead-making is a very traditional ghanaian craft and it is all done by hand. i'm a sucker for "production line" tours (ie louisville slugger, etc)...combine that with the fact
that they were making jewelry and
i was in seventh heaven.

we were given a tour by one of the
co-owners...he walked us through
each stage in making the beads. he personally demonstrated some steps while for others we were able to observe the workers. there are five different kinds of beads that they make and each process is a little different. but in general they first crush glass bottles (beer bottles, jelly jars, ketchup bottles, whatever) in a mortar-pestle thing until they're ground into a fine powder. then they pour the powder
into clay molds made out of the fine
dirt that termites produce when digging. the molds are fired in the kiln (see pic above right), cooled, then the beads are popped out and polished by kneading them in a bowl of sand (pic at right). finally, they are rinsed with water, sometimes painted by hand with various patterns, and strung up into necklaces, bracelets, etc which are sold in the small on-site shop. their motto is, "quality, not quantity" but the little shop was jam-packed with
beautiful beaded items and i think that the eight of us (all girls) bought about $300 worth of stuff. i haven't included any pictures of the final products because word has it that some of you girls may have some beads coming your way...gotta keep you in suspense, you know.